BACKGROUND: Discounting health effects remains a matter of great debate these days. Currently, discussion focuses on whether health effects should be discounted at the same rate as costs or not. High discount rates for health effects are impacting negatively on the cost effectiveness of screening and vaccination programs. Discounting health at a lower rate than wealth has however been argued to result in theoretical inconsistencies and practical unnecessary delays in implementation of health programs. Many authors have therefore assumed that there is a one-to-one relationship between health and wealth. OBJECTIVES:  We investigate the rationality of several assumptions involved towards current discounting procedures. We especially investigated the assumption of a one-to-one relationship between health and wealth. METHODS:  We performed a literature review to link the issues in current methods of discounting health effects with the assumptions involved. Furthermore, we analyzed other possible linkages of health rather than with wealth only. RESULTS:  We noticed that although income might depict the marginal substitution between all commodities, it seems that externalities are not accounted for. Yet, research has shown that all forms of economic growth exert intrinsically negative population health effects among the communities that are most directly involved in the transformations which it entails. This may obviously impact on valuation of health states and preferences, measured using instruments as the EuroQol-5D. These arguments support differential discounting of health effects, and potential further extensions such as differential discounting of life and quality. CONCLUSIONS:  Although there might be a relationship between wealth and health, it appears that externalities may play an additional role on the quality of life. Therefore, it seems that we should regard the discounting problem of health effects as an interlinked system, rather than an equation with only health and wealth and allow differential discounting of, and potentially even within, health effects.